Image Source: Open Access Government
Japan’s Health Ministry is considering expanding the availability of the country’s first approved abortion pill, the Mefeego combined pill pack, to allow clinics without inpatient facilities to use it.
Up to now, the pills could only be administered in hospitals with inpatient capabilities. Following a national survey indicating there had been no severe complications since its approval in April last year, the Ministry is aiming to allow its use in outpatient clinics that can provide 24-hour care and coordinate with inpatient facilities for emergencies.
The Ministry aims to propose the idea for discussion by its expert panel. The Mefeego combined mife+miso pill pack was developed by the British pharmaceutical company Linepharma. Japan has not acknowledged that abortion pills were available and being used far more widely in 80 other countries in 2023, whose experience was not alluded to, either in their initial or soon to be revised rules. (See Lancet, by Justin McCurry, 13 May 2023.)
While some countries allow at-home, self-managed use of the pills [in line with current WHO guidelines], Japan has so far restricted their use to tertiary hospitals, managed by ob-gyns, requiring patients to stay as inpatients for up to 3 days, “until the abortion is fully complete”, making it as expensive as an inpatient D&C.
A Japanese government research team examined approximately 36,000 abortions conducted between May and October 2023 at 2,096 facilities nationwide. No severe complications, such as heavy bleeding requiring transfusion or severe allergic reactions were found. The Mefeego pills were barely used, however — only for 435 abortions – of which 39 resulted in surgical abortions due to incomplete termination. [The latter might have been reduced by a repeat dose of misoprostol.]
Under the Ministry’s “new” proposal, patients could go home without waiting at the clinic, but only provided they live within 16 kms and can return for a follow-up within a week to confirm the abortion. [A very out-of-date requirement.]
“By expanding access to this medication, we aim to offer more (non-surgical) options and ensure equal access to abortion care nationwide,” a health ministry official said. [However, these new proposals are also far more restrictive than WHO guidelines currently call for.]
What the Japanese Ministry puts forward as “caution” is seen by others as keeping abortions with pills expensive and out of reach, not least to protect senior gynaecologists’ income as abortions are available only as private medicine in Japan.
SOURCES: Japan Times, 5 August 2024 ; PHOTO: Japan approves first abortion pill ; Comments in the text, based on: Letter to the Editor: The introduction of 21st century abortion methods in Japan — Policy based on all WHO recommendations is needed, by Marge Berer. IJGO. 2022 Oct;159(1):336-337. DOI: 10.1002/ijgo.14369. E-pub 10 August 2022.]